title: Substantial under-treatment among women diagnosed with osteoporosis in a US managed-care population: a retrospective analysis.
abstract: BACKGROUND
  Multiple therapies are approved for the treatment of osteoporosis (OP), but many patients with osteoporosis may not initiate treatment upon osteoporosis diagnosis.
  
  
  OBJECTIVE
  To characterize initiation of pharmacologic OP treatment among women within 1 year of OP diagnosis in a US managed care population.
  
  
  METHODS
  The retrospective cohort study included women aged ≥55 years with a claims-documented diagnosis of OP who were naïve to OP medications prior to OP diagnosis (index date) during 2001-2010. Continuous enrollment for 12 months before (baseline) and after (follow-up) the index date was required. Patients who received OP medications but did not have an OP diagnosis were excluded. Differences in baseline characteristics between the treated and untreated cohorts were compared using Wilcoxon rank-sum (continuous variables) and chi-square tests (categorical variables).
  
  
  METHODS
  During the follow-up period, the percentages of patients treated with bisphosphonates (alendronate, ibandronate, risedronate, zoledronic acid) and non-bisphosphonates (calcitonin, raloxifene, teriparatide) were determined.
  
  
  RESULTS
  A total of 65,344 patients, mean age 65.7 years, met study inclusion exclusion criteria. During the follow-up period, 42,033 patients (64.3%) received no OP medication and 23,311 patients (35.7%) received OP treatment. A total of 20,200 patients (30.9% of total study population) received bisphosphonates and 3111 (4.8% of total) patients received non-bisphosphonates as their index medication. At baseline, untreated patients were slightly older and had higher rates of hypertension, chronic inflammatory joint disease, diabetes mellitus, and gastrointestinal events (p ≤ 0.01) compared with treated patients.
  
  
  CONCLUSIONS
  Among women aged ≥55 years in a US managed-care population, 64.3% received no pharmacologic treatment within 1 year after being diagnosed with OP. The authors were not able to determine if untreated patients did not receive or did not fill a prescription. Further research is needed to understand the barriers to OP treatment and reasons for non-treatment.
authors.affiliation: Columbia University Medical Center , New York, NY , USA.
authors.forename: Ethel S
authors.initials: ES
authors.lastname: Siris
authors.forename: Ankita
authors.initials: A
authors.lastname: Modi
authors.forename: Jackson
authors.initials: J
authors.lastname: Tang
authors.forename: Sampada
authors.initials: S
authors.lastname: Gandhi
authors.forename: Shuvayu
authors.initials: S
authors.lastname: Sen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002116:Calcitonin / Q000627:therapeutic use; D015331:Cohort Studies; D004164:Diphosphonates / Q000627:therapeutic use; D012968:Etidronic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D007093:Imidazoles / Q000627:therapeutic use; D008329:Managed Care Programs; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D012189:Retrospective Studies; D000068296:Risedronic Acid; D019379:Teriparatide / Q000627:therapeutic use; D014481:United States; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D019379:Teriparatide; D020849:Raloxifene Hydrochloride; D000077211:Zoledronic Acid; D002116:Calcitonin; D000068296:Risedronic Acid; D012968:Etidronic Acid; D000077557:Ibandronic Acid; D019386:Alendronate